Effects of interventions to reduce clinical placement-related psychological distress among nursing students: A systematic review with meta-analysis

Background Clinical placements are essential in nursing education but often cause significant psychological distress, affecting students' well-being, learning outcomes, and patient safety. This systematic review and meta-analysis evaluate the effectiveness of interventions aimed at reducing psychological distress during clinical placements for nursing students. Methods A comprehensive search was conducted across databases including CINAHL, PsycINFO, PubMed, EMBASE, Web of Science, Cochrane Library, ERIC, China National Knowledge Infrastructure, and Wan Fang Data. The review adhered to PRISMA guidelines and used Joanna Briggs Institute (JBI) tools for quality appraisal. Meta-analysis employed a random-effects model for outcomes reported in at least three studies. Results From 2,680 citations, 14 studies met inclusion criteria, comprising five randomized controlled trials and nine quasi-experimental designs. Quality appraisal indicated low to moderate risk of bias. Most interventions were delivered before clinical placements and focused on stress and anxiety coping strategies (n=7), knowledge and psychomotor skills reinforcement (n=5), or mixed approaches (n=2). Coping strategies included cognitive-behavioral therapy, art therapy, and mindfulness. Outcomes primarily assessed stress and anxiety. Meta-analysis showed that pre-clinical interventions significantly reduced stress (SMD = -0.54, 95 % CI: -0.92 to -0.17, p = 0.005) and anxiety (SMD = -0.65, 95 % CI: -0.92 to -0.38, p < 0.001), with moderate effect sizes but high heterogeneity due to varied measurement tools. Conclusions Current interventions effectively alleviate clinical placement-related psychological distress in nursing students despite outcome variability. Future research should incorporate theoretical frameworks, systematically assess student stressors, and standardize assessment tools. Additionally, interventions should address clinical mentors’ needs and provide adequate support to enhance their role in nursing education. Registration: The review protocol was registered on OSF (Open Science Framework) with the following registration number: DOI: https://doi.org/10.17605/OSF.IO/QWXF6 .